The ‘four principles of bioethics’

Sahin Aksoy M.D., Ph.D. and Ali Tenik M.A.

The 'four principles of bioethics' as found in 13^th century Muslim scholar Hz. Mawlana's teachings

ABSTRACT

There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers Beachump and Childress formulized some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'Four Principles' were presented by the authors as universal and applicable to any culture and society Mawlana, a great figure in Sufi tradition, had written plenty of books which not only

guide people how to worship God to be close to Him, but also advice how to lead a good life to enrich his personality as well as to create a harmonious society and a peaceful world.

In this study we aimed to examine the major works of Mawlana and to find out which of these 'Four Principles of Bioethics' exist in the Mawlana's ethical understanding. As we have explored all these principles in Mawlana, we have concluded that, further to the authors' claim that these principles are universal and applicable to any culture and society, these principles have always been existed in different moral traditions in different ways, to which Mawlana's teaching might be presented as a good example.

INTRODUCTION

Ethics can be described as a sub-branch of applied philosophy that seeks 'what is the right and the wrong, the good and the bad set of behaviors in a given circumstance'. Bioethics, on the other hand, is a quasi-social science that offers solutions to the moral conflicts arise in medical and biological science practice.

The discussion and the resolution of moral conflicts throughout the history have varied due to the time and place, and the faith and the cultural tradition of the given society. However owing to the migrations and the mass movements of the people the homogeneous and traditional societies replaced with multi-cultural and multi-faith societies. This new setting required new sets of ethical principles to resolve the new moral dilemmas.

There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers Beachump and Childress wrote a book called 'Principles of Biomedical Ethics' in 1979 [1]. In this book they formulized some ethical principles namely 'respect to autonomy', 'non-maleficence', 'beneficence' and 'justice'. The authors presented these 'Four Principles', which have almost always been existed and governed the ethical behavior of human societies, as applicable to any culture and society. The authors' claim has been tested by the researches conducted in different cultures and societies [2]. In this article we to explore the roots and traces of these principles in Islamic tradition, and to find out if Mawlana used these 'four principles' in his teaching.

Mawlana Jelalu'd-din Rûmi: His Life and Thoughts

Muhammad Jelalu'd-din, or with his renowned name Mawlana Jelalu'd-din Rûmi (1207-1253) was born in Balh in North Afghanistan. He was one of the leading scholars who was able to overcome the existentialist paradox and reached the universal existence. He was born into a family that was well known with scholars and Sufis in it.

Mawlana's first teacher was his father Bahâeddin Walad, a famous theology (kalâm) scholar who was known as 'king of scholars'. His character was shaped in an authoritarian family from his early ages. His family was an orthodox religious family respected by the society. However the family was threatened and harassed by some scholars who wanted to be good with corrupt governors, therefore they had to leave Balh [4].

The family migrated from one learning centre to another in Middle East, and finally they decided to settle in Konya, capital city of Anatolian Saljuks. This 'compulsory' trip had helped the enlightenment of Mawlana. Since his father was a scholar he found the chance to meet with many famous scholars and learn many things from them in his young age. He had reached a very high level in fiqh (Islamic law) and kalam (theology) that he was offered to come to his father's position after his pass away. Mawlana had interested with external sciences ('ilm-i zahir) until his father's death. After that he joined to Sufi order and deepened his knowledge on this.

Shams-i Tabrizi is very important in Mawlana's personal and intellectual life. He came to Konya in 1244. When Mawlana met with him his life and thoughts had radically changed. Shams had to leave Konya for two times due to social pressure, and in the end he went away and did not come back again. This had affected Mawlana very badly that he narrated in his Divan-i Kabir (The Big Book) [5, 6]. This longing continued until Mawlana found Shams 'within himself'.

When the Mawlana's writings are examined it can be seen that his ideas, beliefs and ideals were mostly concentrated on with the God and the future. He was a scholar who explored the 'inner power' of man. To him, the 'real' self is what Allah created within him, not the one, which developed with the influence of his father and the environment, and this was the 'universal self', the level that only 'complete man' can reach.

Mawlana established 'Mawlawi Sufi Order' [7], whose followers had become to be backbones of Anatolian 'Diwan Literature' (Ottoman Poem)' [8]. Mawlana is known as a man of letters as well as a theologian. His books are the most distinguished works of Persian and Turkish literature [9]. These works are concrete evidences that he was not only a tariqat (Sufi Path) founder, a sheikh and a spiritual guide but also a complete scholar (alim). He went beyond all these worldly titles with supreme love in his spiritual world, and he reached to the 'universal man'. He educated people not in tekke (dervish lodge) but in madrasa (school) [10].

Mawlana has not only influenced the East but the West too. French Ambassodor J. De Wallenbourg (d. 1806), Austrian J. Von Hammer-Purgtall (1774-1866). German Friedrich Ruckert (1788-1856), Helmut Ritter, Hans Meinke and Goethe were among the writers and thinkers who had written books on Mawlana and his thoughts [11]. Even today, the annual festival and Remembrance Day for Mawlana attracts hundreds of people from all around the world. These activities take place in Konya in every December and last one week with various activities.

Mawlana delivered very important messages with his writings both in poem and prose style. His major works are: 1) Mathnawí; the primary book of Mawlawi Sufi order; 2) Diwan-i Kabir; (The Big Book) written in lyric poems form. Consist of Ghazals and Rhubais [11] 3) Mektubat; (Letters) consists of letters written in Persian; 4) Fihi Mâ Fîh; consists of Mawlana's talks; 5) Mecâlis-i Seb'a; consists of Mawlana's preaches.

Now we shall move to search for the four principles of bioethics in Mawlana's works.

DISCUSSION

'Autonomy' in Mawlana's Works

Autonomy literally means self-rule. Beauchamp and Childress use the phrase 'respect for autonomy', adding the clarifying distinction between one's capacity for self-rule and another's reaction to that capacity [1]. Respect for autonomy is basically stands on the fundamentally appreciated and legally supported concept of individual liberty, particularly with regard to what one does with one's body or allows to be done to it. In Islam, Muslims are expected to act with `ilm (knowledge), and knowledge is significantly important in decision making in Islam. It could be possible to say that absolute knowledge is predominant to individual autonomy. Islam does not permit man to act as he wishes but limits him with certain rules

Mawlana argues that every creature has a special form of free will. To him, creatures' will elevates stage by stage to the God's will. If man is thankful in every stage Allah bestows him with new 'goods'. If a man struggle with his own bad attributes and succeeds, he, then, acts with Gods will and he is granted with praise, as the prophet was praised by Allah (means God in Islamic understanding). Qur'an (the holy book of Muslims) reads;

“(O Muhammad!) you threw not when you did throw but Allah threw, that He might test the believers by a fair trail from Him. Verily, Allah is All-Hearer, All-Knower” [13].

Mawlana accepts man as a supreme creature granted with 'ilm (knowledge). Therefore he has an inherent right to choose. He believes that ones decision shall be respected if it is taken autonomously with 'ilm [14]. He says, the individual also should be ready to accept the consequences of his autonomous decisions. He gives some examples on this one of which was Adam's story narrated in the Qur'an; Adam ate the forbidden fruit in the Heaven, and he understood his misdeed he regretted by telling;

“They said; “Our Lord! We have wronged ourselves. If you forgive us not, and bestow not upon us Your Mercy, we shall certainly be of the losers” [15].”

Adam, despite being a prophet in Islamic understanding, was faulty in his action, but free even to make mistakes provided that it was with 'ilm and free will [14]. Mawlana stresses the importance of people taking the responsibility of their actions. He says;

“Whatever work you incline, you see your might there.

Whatever work you do not wish to do, you refer it to the God as if an obligation” [14].

This is a sign of cowardice, weakness and laziness. He says that since Allah is generous, He gave man both knowledge ('ilm) and will-power. In order to explain what he said Mawlana tells an analogy;

“A man gets into a garden to steal fruits. When the owner catches him he says “God's creature eats fruit from God's garden with the God's favour.” The owner of the garden ties him to a tree and starts to beat. When the thief complains he says, “God's creature hits the back of another God's creature with the God's stick. The stick is His, the back is His I am just a means, why do you complain?” [14]

Mawlana balances God's intervention and man's will-power in every action. He says, man wants, God creates. The freedom of choice for man was created with God's will. His will is like a horseman rides on man's will [14]. In this matter Qur'an reads;

“…..And He knows whatever there is I (or on) the earth and in the sea; not a leaf falls, but he knows it. There is not a grain in the darkness of the earth nor anything fresh or dry, but is written in a Clear Record [16]”

and

“.......There is not a moving (living) creature but He has grasp of its forelock.....” [17]

Therefore, since whatever one decides there is God's share in it, one's autonomous

decision shall be respected, provided that it is done with 'ilm.

'Beneficence' and 'Non-Maleficence' in Mawlana's Works

Beneficence generally means doing good, or doing acts of kindness. Over and above refraining from doing harm to others, the principle of beneficence requires us to be concerned and promote the welfare of others. The term beneficence implies acts of mercy, kindness, charity, altruism, love and humanity. It is the central theme of ethical theories such as utilitarianism (the principle of utility) and common morality theories. In these theories, beneficence is conceived as the aspect of human nature that motivates us to act in the interest of others and is considered to be the goal of morality itself.

Closely related to the maxim of traditional medical ethics 'Primum non nocere: above all (or first) do no harm', the principle of non-maleficience means not causing harm to others. We do not generally have the obligation to benefit other people, yet we at least have the duty not to harm them. When health care professionals try to promote the welfare of patients, they inevitably run the risk of harming them. Therefore, balancing benefit over harm to produce the maximal good for their clients is a fundamental consideration.

Mawlana was not only a mystical and idealist Sufi but he was also a person who had been free from individualism and personal passion. He promoted love and humanism to the society. In morality he suggests everyone to follow a 'Wiseman' so to incline towards goodness, kindness and beneficence. He himself was inclined towards goodness, kindness, love, tolerance and beneficence by the teachings of Qur'an.

Mawlana believes that the religion is not only for a nation or a society but also for the all humanity. Every deed starts from Allah and returns to Him. The purpose of life is having 'more life' and being 'better' than yesterday. Although he was a great Sufi he did not suggest causing pain to his self [10]. He says that being beneficent to others is a worship, since it is commanded by God. Allah commands men to be nonmaleficent and beneficent to others. He says in the Qur'an;

“.....So hasten towards all that is good...........” [18]

and

“.......so strive as in a race in good deeds..........” [19]

Mawlana writes in Mathnawi that, being helpful to someone who is ill or has some problems is like a charity. Ailing person's heart is like a house full of smoke, being merciful and beneficial to him is like opening a window to this house and save him from suffocation [14]. If someone acts beneficially to others God rewards him generously in return. Qur'an reads;

“Surely! Allah wrongs not even of the weight of an atom, but if there is any good (done), He doubles it, and gives from Him a great reward [20].”

'Good' and 'bad' had always existed in Mawlana's understanding on world. He was aware of these two concepts that were created by God for man. God created 'good' and 'bad' to test man. Although God created both He wants 'good' for His servants. It is like doctor needs disease to practice his talent though he wants health for all; or baker needs hunger to sell bread though he wants everybody be full. Qur'an reads;

“Everyone is going to taste death, and We shall make trial of you with evil and with good, and to Us you will be returned [21].”

Mawlana writes in his Mathnawí:

“O young man! You cannot know good without knowing bad.

Opposite can be seen with its opposite” [14].

Mature person sees and knows this divine order, abandon being selfish, and fulfils its

responsibility. Mawlana suggests that ideal man overcomes his egoism and commit himself to be beneficial to his fellow beings. His philosophy is based on love for human, since it is shaped with Qur'anic command of “….do good. Truly Allah loves the good-doers” [22].

Another feature of a virtues man is not to consent a malicious act without struggling against it. Accepting a malicious act is same as being maleficent. So a virtues man shall be beneficent and non-maleficent to others. Qur'an reads;

“Whoever does righteous good deed it is for (the benefit of) his ownself, and whosoever does evil, it is against his ownself, and your Lord is not at all unjust to (His) slaves” [23].

Mawlana writes; “The Prophet said: if man knew the reward for beneficence, he would surely be beneficent to others [14].” Every Muslim is assured that he will be rewarded generously in return for their beneficent deeds. Allah tells them in the Qur'an that

“Whosoever intercedes for a good cause will have the reward thereof, and whosoever intercedes for an evil cause will have a share in its burden. And Allah is Ever All-Able to do (and also an All-Witness to) everything” [24].

Mawlana suggest not only be beneficent to human beings but also to all creatures of Allah.

“We, even, feel sympathy to dogs as people throw stone to them. I also pray in favour of the dog that bites me, I say ”O the Merciful! Please change his behaviour, he does not bite people so not to be stoned” [14].”

With this example Mawlana also says that a mature person should be good and beneficent to the people who are maleficent against him. May be one day a light switches on in maleficent person's heart and he is enlightened, so he may know the satisfaction of being good and maleficent. He writes;

“There are people in the world who are to help poor. They run for help whenever they are called. They hear the voice of poor in everywhere. They are like a mainstay to a ruined building and a doctor to an incurable disease. They are representative of love, justice and mercifulness [14].”

Ones 'hunt' whose aim is being good and beneficent is mercy. Medicine seeks for disease in the world and treats it wherever it finds. As water flows from higher to lower, they always tend to help needy. It is also command of God to help people in need;

“Worship Allah and join none with Him in worship, and do good to parents, kinsfolk, orphans, the poor who beg, the neighbour who is a stranger, the companion by your side, the wayfarer (you meet), and those (slaves) whom your right hands possess. Verily, Allah does not like such as are proud and boastful” [25].

In Mawlana's philosophy 'tolerance' is like 'bread and butter' for humanity. He took this lesson from the Creator. He commands in the Holy Qur'an;

“......Help you one another in Al-Birr and At-Taqwa (virtue, righteousness and piety); but do not help one another in sin and transgression. And fear Allah. Verily, Allah is Severe in punishment.” [26]

To him tolerance is the main feature of a mature person. In his understanding tolerance means love, respect and beneficence [14]. Mawlana calls people to clean the 'thorns of maleficence' on his road to maturity [14]. Qur'an reads in this matter;

“The good and the evil deed cannot be equal. Repel (the evil) with one which is better (i.e. Allah ordered the faithful believers to be patient at the time of anger, and to excuse those who treat them badly), then verily! He, between whom and you there was enmity, (will become) as though he was a close friend.” [27]

Non-maleficence enables you to make new friends. God's promise “So whosoever

does good equal to the weight of an atom, shall see it. And whosoever does evil equal to the weight of an atom, shall see it” [28] has not changed. Mawlana believes that it is self's fault to be maleficent. That's why the self should be struggled. If man can 'destroy' his self he will be away from maleficence [14].

Besides being beneficent to others Mawlana has a different approach to the problem of maleficence. He argues that our opinions regarding to maleficence is relative. For instance a substance may be a toxin for one but an antitoxin (or a cure) for another. Generally, people call the things whom they do not like as bad. But some events and actions that seem disfavored at first sight may be a blessing for us. With this argument Mawlana approaches to be a consequentialist. In this matter Qur'an says;

“………and it may be that you dislike a thing which is good for you and that you like a thing which is bad for you. Allah knows but you do not know.” [29]

Mawlana suggest that man's duty in the world is not to give in to 'one-thousand-one evils', and not to say “this is my bad fate”, but to struggle against all. If man becomes

to be beneficent to others in this way he is going to be rewarded. God promise in the

Holy Book;

“Whoever brings a good deed shall have ten times the like thereof to his credit, and whenever brings an evil deed shall have only the recompense of the like thereof, and they will not be wronged.” [30]

In Mawlana's thought good-bad and beneficent-maleficent were transcended beyond. When man passes the 'stages of existence' (i.e. non-living being, living being, plant, animal and human), he is a candidate to be a member of a 'non individualistic world'. He reaches the stage of 'conscious being' [14].

When we consider the principle of beneficence in Islamic tradition, on the one hand there is not much to say about it, since it is so intimate to the principle of non-maleficence, but on the other hand it is so dominant to other principles that we can say the principle of beneficence is the starting point in all kinds of human relations. Prophet Muhammad says;”The best of you is the one who is most beneficial to others” [31]. Therefore, the principle of beneficence is significantly stressed in Mawlana's work too.

'Justice' in Mawlana's Works

Explicated by various philosophers as 'fairness', 'desert' and 'entitlement', justice is interpreted as fair, equitable and appropriate treatment in the light of what is due or owed to persons [1]. Justice is suggested to be the first virtue of social institutions, as truth is of systems of thought [32].

It proclaims the moral obligation to act on the basis of fair distribution between competing claims. As applied in the field of health care ethics by Gillon, obligations of justice were subdivided into three categories: fair distribution of scarce resources (distributive justice), respect for people's rights (rights-based justice) and respect for morally acceptable laws (legal justice) [33].

Justice is very much central to Islamic teaching. There are plenty of Qur'anic verses and Prophet's advice on this matter. Mawlana says that if justice is like watering trees, injustice is like watering the thorns. Justice is putting a blessing where it belongs not feeding everyone. Justice is being respectful to personal and legal rights of other people and all the creatures. This is what Allah commands;

“……..Verily! Allah loves those who are equitable” [34].

Mawlana says that justice controls anger, desire and inclination. If people do enjoy justice, and if the 'Just God's command do not guide them, even if the half of the community watch the other half justice cannot be established. God put everything justly where it belongs. One of His attributes is the 'All Just'. As He is the 'All Just',

He commands humans to be just;

“Allah commands justice, doing of good, and giving to kith and kin, and forbids all indecent deeds, and evil and rebellion: He instructs you that you may receive admonition” [35].

CONCLUSIONS

Mawlana, as an important Islamic theologian and philosopher, had written on many things including moral philosophy. He, like many other thinkers around the world, had preached for a better and more harmonious life. In this study we tried to demonstrate that, as was demonstrated in previous studies [36,37], it is fairly possible to detect the roots of the 'Four Principles of Bioethics' in Islamic tradition and in Mawlana's works with different emphasis to the individual ones compare to the classical understanding of them in the Western Bioethics. We hope that this study will make a positive contribution to the mutual dialogue and understanding between two radically different traditions namely Islamic and Western ones.

REFERENCES

1) TL Beauchamp and JF Childress: Principles of Biomedical Ethics, 4th Edition, Oxford

University Press, New York, 1994.

2) DFC Tsai: Ancient Chinese medical ethics and the four principles of biomedical ethics.

Journal of Medical Ethics 1999; 25:315–21.

3) AR Aresteh: Rûmi the Persian: Rebirth in Love and Creativity. Dutton, New York, 1973.

4) AV Arberry: Mystical Poem of Rûmi. Chicago, 1968.

5) MC Rûmi: Divan-i Kebîr. 2nd edition, Kultur Bakanligi Yayinevi, Ankara, 2000. (In Turkish)

6) RA Nicholson: Selected Poems from the Divan-i Sham-i Tabriz. Cambridge University

Press, Cambridge, 1961.

7) A Golpinarli: Mevlânâ'dan Sonra Mevlevîlik (Mawlawi Order After Mawlana). Inkilap

Yayinlari, Istanbul, 1934:441-454. (in Turkish)

8) Ottoman Poem: A poetry style, which was developed around Ottoman Palace in 16th-19th

century, and could be understood only by well educated people. The themes were generally

religion and Sufism.

9) H Mazioglu: Mevlana ve Yasama Sevinci (Mawlana and Happiness of Life). Konya Turizm

Dernegi Yayinlari, Konya, 1981:30-39. (in Turkish)

10) A Golpinarli: Mevalana Celâleddin. 4th edition, Inkilap Yayinlari, Istanbul, 1985:223.

11) W Chittick: The Sufi Path of Knowledge: The Spiritual Teachings of Rûmi. Sunny Press,

Albany, 1983.

12) Ghazal: A poetry style which was written on couplets. The subjects are mostly love and the

features of beloved.

13) Al-Anfal 8:17.

14) MC Rûmi: Mesnevi (Mathnawí) Vol. VI, Milli Egitim Bakanligi Basimevi, Ankara, 1992:418-

424. (in Turkish)

15) Al-A'raf. 7:23.

16) Al-An'am 6:59.

17) Hûd 11:56.

18) Al-Baqarah 2:148.

19) Al-Mâ'idah 5: 48.

20) An-Nisâ' 4:40.

21) Al-Anbiyâ 21:35.

22) Al-Baqarah 2:195.

23) Fussilat 41:46.

24) An-Nisâ' 4:85.

25) An-Nisâ' 4:36.

26) Al-Mâ'idah 5:2.

27) Fussilat 41:34.

28) Az-Zalzalah 99:7-8.

29) Al-Baqarah 2:216.

30) Al-An'am 6:160.

31) EC At-Tahâwî: Sharh Ma'an âthâr. (The interpretation of the meanings of the hadîth).

Vol.4, Cairo, (no publication place and date):326-8.

32) JA Rawls: A Theory of Justice, Oxford University Press, Oxford, 1973:3.

33) R Gillon: Medical Ethics: Four Principles Plus Attention to Scope, British Medical Journal, 1994; 309:184-8.

34) Al-Hujurât 49:9.

35) An-Nahl. 16:90.

36) GI Serour: Islam and the Four Principles. In: Principles of Health Care Ethics. (Edited by Raanan Gillon) John Wiley & Sons Ltd., London, 1994:75-91.

37) S Aksoy and A Elmali: 'Four Principles of Bioethics' as found in Islamic Tradition.

Medicine and Law Journal. (In Press)